Alcohol: How much is too much?

Why it is imperative for people who have problems due to alcohol to seek help from a qualified medical practitioner

“ I take a glass of arrack every day”
“I take a 1/4 a bottle of arrack once in a month”
“Taking a glass of wine at the end of the day relaxes me”

These are common statements people make about alcohol. We will find out how accurate/healthy these views/ideas are.

What is alcohol?  

All alcoholic beverages contain ethanol (the chemical name), in various concentrations. How it affects the body varies from person to person (whether one is a male or a female and one’s genetic make-up, what other illnesses one has and the medications one is taking), amount of ethanol one takes and the occasion on which one takes alcohol.

Ethanol is digested in the gut by various enzymes. Due to certain variations of these enzymes seen in Asians, they experience more detrimental effects of alcohol compared to Europeans. Also, though some people can ‘tolerate’ alcohol in high amounts and boast that they ‘drink a lot but hardly lose control’, these people are at more risk of alcohol-induced health-related problems than those who get ‘drunk’ with small amounts of alcohol.

How does alcohol act on the brain? 

The human brain is the source of our feelings like happiness (emotions), thoughts like ‘I am able to do this job’ (cognitions), movements like raising the arm (voluntary as well as involuntary), perceptions like hearing, executive functions like planning and behaviours like running away from danger. Each of the functions is coordinated by a specialized area in the brain. Likewise, there is an area called ‘reward system’, which when stimulated by a certain activity/substance/situation/event releases a chemical (a neurotransmitter) called dopamine. When dopamine is released in the ‘reward system’, it gives us pleasure, which is essential for us to be healthy, connected and happy. Since we all like to experience pleasure repeatedly, we tend to repeat the same activity/ take a particular substance again to experience pleasure.

In day to day life, some activities which increase dopamine in the reward system are having sex, eating tasty food, being with loved ones, going on a holiday and achievements. Alcohol (and all the other substances which can lead to addiction) also releases dopamine in the reward system and gives pleasure, so people tend to use it repeatedly, despite deleterious consequences (Although this ‘pleasure effect’ depends a lot on the surrounding environment one takes alcohol as well. For an example, one can ‘experience’ ‘ pleasure’ when alcohol is taken at a party. The same person might weep while taking alcohol at a funeral house).

Alcohol releases more dopamine than any other usual day-to-day instance described earlier. Therefore, if the person continues to take alcohol, he might not experience pleasure in day to day life, but only with alcohol.

In psychiatry, we call this ‘Alcohol highjacking the reward system’. Therefore, he gradually starts to withdraw from ‘normal pleasurable activities’. This neglect of other pleasures leads to bad consequences; disruption of his family, his job and his health. Due to lack of pleasure in other activities, his main source of pleasure becomes alcohol, setting in a vicious cycle.
At this point, he may have developed features of dependence (addiction), which is a serious mental illness. In addition with long term use the person starts to experience unpleasant effects (withdrawal symptoms; sleeplessness, tremors of hands, nausea, body aches) when he does not take alcohol. So to relieve these unpleasant symptoms he continues to take alcohol.

The human brain continues to develop until one becomes 24 years or so. Therefore, the consequences of taking any substance of abuse like alcohol before this age can have detrimental effects (like being more prone to develop mental illnesses, impaired memory) on the developing brain.

Even ‘low-risk drinking’ can affect an individual’s alertness/attention, reaction time (the time is taken to respond to a stimulus, eg: applying breaks after seeing a truck coming on to your vehicle), memory and decision making abilities.

‘Low-risk drinking (LRD)’ 

The concept of LRD is being intensely debated in the field of medicine. The ‘limit of low-risk drinking’ has been coming down over the past decades and the most recent is less than 100g of alcohol per week. But even this ‘low-risk drinking limit’ does not mean that it is better than abstinence. All the research evidence favours very much towards abstinence as the rates of accidents and premature deaths due to multiple causes (like heart diseases, strokes, cancers, accidents, violence etc) are lower among people who do not consume alcohol at all

How to measure the amount of alcohol in alcoholic beverages? 

Each and every type of liquor shows the concentration of pure ethanol (the chemical in liquor) in it.

Eg: v/V -40%

The above type of liquor has 40 ml of pure ethanol in 100 ml. Ten ml of pure ethanol is equivalent to 8 grams of pure ethanol or 1 standard unit of alcohol. Therefore, if one takes 100 ml of above liquor it contains 32 grams of pure ethanol or 4 standard units of alcohol. The current recommendation for ‘low-risk drinking’ is only 2 units/ 16 grams of pure ethanol a day.
One should not take alcohol even in these quantities if he/she intends to drive, operate machinery, is ill, is pregnant or is below the age of 21 (below 24 should be the ideal as the brain continues to develop up to around this age). If one takes alcohol even in these quantities under these circumstances it is not ‘LRD’.

The effects of alcohol on the body/ mind/family/ society

Effect on the brain/mind

Alcohol impairs memory, judgement, coordination of movements and attention and also causes drowsiness. It also reduces the speed of our movements. Since it makes people dis-inhibited, they tend to behave inappropriately and aggressively. People who consume alcohol are at higher risk of developing mental illnesses like depression/ anxiety disorders/ suspecting the partner to have other sexual relationships etc.

 

 

The human brain continues to develop until one becomes 24 years or so. Therefore, the consequences of taking any substance of abuse like alcohol before this age can have detrimental effects (like being more prone to develop mental illnesses, impaired memory) on the developing brain

Effects on the body

1. Increased risk of diseases in the heart
2. Increased risk of cancers
3. Babies with mental retardation and other developmental abnormalities if the mother consumes alcohol during pregnancy
4. Liver damage/ cirrhosis
5. Impaired sexual desire/ erectile dysfunction
6. Increased susceptibility to infections

Effects on the family

1. Family conflicts
2. Financial problems
3. Adverse effects on children’s education
4. Increased risk of children/ spouse developing mental illnesses/ mental health problems

Effects on society

The number of people dying/ getting injured in road traffic accidents and other accidents is very high in Sri Lanka. Around 3500 people die on roads per year. (If we compare this number with deaths due to dengue, it is 10-15 times more!). There is a dearth of data regarding people who become permanently disabled (Bedridden, altered memory etc) following the injuries they sustained. The common factor in most of these accidents is alcohol use. It is not uncommon to hear pedestrians and others getting killed due to their alcohol use.

Therefore it is apparent that one’s alcohol use can cost many others their health/ lives and it is ‘most of the time not only a problem limited to him/her only’.  If we consider some of the commonly heard statements in day to day life mentioned above, in the first and third instances they take alcohol daily. The WHO recommends, if one wants to take alcohol with minimal risks, there should be at least 2 alcohol-free days a week. In the second instance, he consumes about 7 units of alcohol at one go, even though once a month. This is binge drinking and can lead to consequences of alcohol intoxication (Poor memory, poor judgement, accidents etc)

Experiencing the following could be features of ‘alcohol dependence’

1. Inability to control the amount of alcohol once started, even if you want to stop
2. Irresistible desire to take alcohol (Craving)
3. Experiencing withdrawal symptoms when off alcohol
4. Having no other source of pleasure
5. Increasing the amount of alcohol to experience the same effects of alcohol (Tolerance)
6.Experiencing difficulties at your workplace or in the family due to alcohol-related behaviours
7. Having to take alcohol as the first thing in the morning to steady yourself (Using alcohol as an ‘eye-opener’)

Who are at high risk of developing alcohol use disorders

1. When a first-degree relative has an alcohol use problem/ depression
2. When one has depression/ social anxiety
3. When one’s coping skills (problem-solving abilities) are inadequate
4. Frequent acquaintance with people who use alcohol regularly
5. People who start to use alcohol in their teens

If one suffers from any of the consequences mentioned above it is better to go to a psychiatry clinic and get help. Despite the stigma attached to alcohol dependence (addiction), it is a serious, but treatable mental illness. It is imperative that people who have problems due to alcohol consumption seek help from a qualified medical practitioner.

The writer, Dr Dewasmika Ariyasinghe, is a Senior Lecturer, Department of Psychiatry, Faculty Of Medicine, University of Peradeniya, and Honorary Consultant Psychiatrist, Teaching Hospital Peradeniya.